# Rectal Prolapse — GCMD Library living collection

Everything in the library about rectal prolapse — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 53 cited statements

## Episodes
### Surgical Management
- [Rectal Prolapse Repair Following a Posterior Sagittal Anorectoplasty](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723) — video · 4:55 · [machine version](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723.md)

### Evidence & Research
- [Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942) — video · 0:39 · [machine version](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942.md)

### Case-Based Learning
- [Colorectal Quiz Episode 2: When to redo a PSARP](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580) — podcast · 18:15 · [machine version](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580.md)

### In-Depth Reviews
- [Rectal Prolapse Rapid Fire: Update Course 2015](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983) — video · 5:40 · [machine version](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983.md)
- [Update Course Rewind: 2020 Colorectal Part 2](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834) — podcast · 11:01 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=0) Diagnostic workup and medical management of rectal prolapse (Ep 1)
- [2:16](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=136) Surgical options and audience experience (Ep 1)
- [4:30](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=270) Literature review of recurrence rates and ventral mesh rectopexy (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=0) Introduction: The challenge of redo anorectoplasty decisions (Ep 2)
- [3:19](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=199) Case 1: Seven-year-old boy with posterior misplacement and prognostic factors (Ep 2)
- [8:15](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=495) Case 2: Four-year-old girl with vestibular fistula and visual assessment techniques (Ep 2)
- [11:00](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=660) JPS study outcomes: Benefits and timing of redo operations (Ep 2)
- [14:43](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=883) Borderline cases and decision-making philosophy (Ep 2)
- [0:01](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=1) Introduction to Update Course Rewind and Rectal Prolapse Topic (Ep 3)
- [0:59](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=59) Initial Case Presentation and Conservative Management Approach (Ep 3)
- [3:51](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=231) Sclerotherapy and Surgical Options for Refractory Cases (Ep 3)
- [8:36](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=516) Psychological Factors and Multidisciplinary Approach (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=0) Introduction and Clinical Context (Ep 4)
- [0:54](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=54) Initial Surgical Steps and Sphincter Preservation (Ep 4)
- [1:47](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=107) Rectal Mobilization and Setup (Ep 4)
- [2:47](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=167) Anoplasty Construction and Completion (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=0) Rectal Prolapse Repair Morbidity After ARM Surgery (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- For anorectoplasty, if you don't get it perfect, you might not have the best outcomes, which separates it from other surgical procedures. — Jason Frischer (opinion) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=0)
- The original malformation in Case 1 was a prostatic fistula. — Marc Levitt (clinical) [Ep 2 · 4:30](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=270)
- The patient in Case 1 has a tethered cord and a sacral ratio of 0.66. — Marc Levitt (clinical) [Ep 2 · 4:40](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=280)
- The family doesn't really care how technically elegant is your analplasty. What they care about is whether that analplasty that you make is going to work and is the child going to be clean and in normal underwear. — Jason Frischer (opinion) [Ep 2 · 5:50](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=350)
- The higher the malformation, the worse the prognosis. — Jason Frischer (clinical) [Ep 2 · 6:25](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=385)
- A sacrum ratio of 0.7 or greater usually means normal or close to normal sphincters and good muscle tone, indicating that spine innervation of that area is probably good. — Jason Frischer (clinical) [Ep 2 · 6:35](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=395)
- Patients can come with associated spinal anomaly, most commonly tethered cord, but the worst is a myelomeningocele, and those patients have much more trouble with continence. — Jason Frischer (clinical) [Ep 2 · 6:40](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=400)
- Visual cues for identifying correct sphincter location include the anal dimple, a midline raised area where the sphincters are, the ellipse, color change, indentation or raised area, and appropriate perineal body length. — Marc Levitt (clinical) [Ep 2 · 7:29](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=449)
- It's amazingly common to have a mislocated anus, either because the surgeon misses where the center is during laparoscopic pull-through or opens the PSARP incision first. — Jason Frischer (clinical) [Ep 2 · 7:44](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=464)
- A key pitfall is opening the PSARP incision first; instead, mark the sphincters first, then open the PSARP so you don't get confused when placing the anoplasty in the correct location. — Jason Frischer (clinical) [Ep 2 · 8:05](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=485)
- Case 2 patient was born with a vestibular fistula, has a normal spine and an excellent sacrum, indicating a much better prognosis for bowel control. — Marc Levitt (clinical) [Ep 2 · 8:40](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=520)
- The electrical stimulator used is the same one that anesthesia uses for their train of four, with an inexpensive connection with little pins. — Marc Levitt (clinical) [Ep 2 · 9:50](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=590)
- You have to tell your anesthesiologist not to give skeletal muscle relaxant because the stimulator is a little bit weaker than the traditional stimulator. — Marc Levitt (clinical) [Ep 2 · 10:10](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=610)
- In higher malformations such as a bladder neck fistula in a boy, the sphincter complex isn't always where you think it's going to be and is sometimes more anterior than anticipated. — Jason Frischer (clinical) [Ep 2 · 10:19](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=619)
- If you know the anatomy is off, you should do the redo, and there's an advantage to getting the anatomy right the younger the child is. — Marc Levitt (opinion) [Ep 2 · 13:28](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=808)
- For a two-year-old with a mislocated anus or bad prolapse, offer a redo and let them live in diapers for a year or two with better anatomy, then see if they can successfully potty train. — Marc Levitt (opinion) [Ep 2 · 13:50](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=830)
- Many patients present after the age of potty training because they're incontinent, and evaluation reveals the reason is they don't have the best operation—their anus isn't in the right place. — Marc Levitt (clinical) [Ep 2 · 14:20](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=860)
- For patients presenting with incontinence after potty training age, do the redo and usually add a Malone at the same time so they can learn how to get control with their new anatomy before attempting voluntary bowel movements. — Marc Levitt (opinion) [Ep 2 · 14:30](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=870)
- The process of learning control with new anatomy after redo and Malone may take 6 to 12 months. — Marc Levitt (clinical) [Ep 2 · 14:35](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=875)
- For a patient with a mislocated anus that's 50% within the sphincter complex, three and a half years old and fecally incontinent, one approach is to redo them, do a Malone, get them perfectly clean mechanically, then see if they can develop bowel control. — Marc Levitt (opinion) [Ep 2 · 15:03](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=903)
- An alternative approach for borderline cases is to let the child take their car out for a ride first and see how it works—if it drives well, stay with that anatomy; if not, then consider the redo. — Jason Frischer (opinion) [Ep 2 · 15:19](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=919)
- If patients haven't declared their continence yet because they're not old enough to do so from a behavioral point of view, give them a chance—they may succeed. — Marc Levitt (opinion) [Ep 2 · 15:45](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=945)
- Rectal prolapse is a relatively unusual problem in pediatric surgery. — Eunice Huang (epidemiological) [Ep 3 · 0:59](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=59)
- Children develop rectal prolapse because of their anatomy: they have a very weak pelvic floor and the rectum is very low, so it tends to pop out easily if they strain hard enough. — Eunice Huang (clinical) [Ep 3 · 2:44](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=164)
- Conservative treatment includes managing constipation, teaching proper toilet sitting with a smaller seat so children don't fall through, providing a step for proper upright posture, and limiting time on the toilet without distractions like iPads. — Eunice Huang (clinical) [Ep 3 · 3:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=193)
- Dr. Sean St. Peter's sclerotherapy technique uses 5 ccs of Sotradechol injected in 4 quadrants with any remaining volume injected in between. — Shawn St. Peter (clinical) [Ep 3 · 4:28](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=268)
- Sclerotherapy has a low threshold for use because it is simple, innocuous, and can provide a window of a couple months without prolapse that allows younger children to see less frequent episodes. — Shawn St. Peter (opinion) [Ep 3 · 4:11](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=251)
- A systematic review in the Journal of Pediatric Surgery included 27 publications with 900 patients: 300 underwent sclerotherapy (8 studies, 3 sclerosing agents) and 600 underwent operative management (22 studies, 17 different procedures). — Eunice Huang (epidemiological) [Ep 3 · 5:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=310)
- The large number of different operative procedures (17 procedures across studies) indicates uncertainty about which is the best procedure for rectal prolapse. — Eunice Huang (opinion) [Ep 3 · 5:46](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=346)
- Transabdominal procedures have a pretty high success rate for correcting rectal prolapse based on published data. — Eunice Huang (clinical) [Ep 3 · 5:56](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=356)
- The complication rate of sclerotherapy is mostly negligible, complications are acute, and there is minimal risk of long-term problems. — Eunice Huang (clinical) [Ep 3 · 7:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=434)
- Patients with rectal prolapse should be evaluated to rule out underlying diseases, especially cystic fibrosis. — Eunice Huang (guideline) [Ep 3 · 7:41](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=461)
- Some patients with rectal prolapse and anxiety develop a feedback loop where prolapse becomes an emotional release mechanism for evacuating stool. — Eunice Huang (clinical) [Ep 3 · 9:34](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=574)
- Pelvic floor therapy is useful in strengthening pelvic floor musculature and, when combined with sclerotherapy and support for anxiety, leads to more durable outcomes. — Eunice Huang (clinical) [Ep 3 · 9:34](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=574)
- The anoplasty location should be checked with an electrical stimulator to confirm it is well located with circumferential contractions. (clinical) [Ep 4 · 0:44](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=44)
- Full thickness rectum is incised off of the skin edge while preserving the sphincter muscle. (clinical) [Ep 4 · 1:27](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=87)
- Leaving the right side of the anoplasty untouched reduces the risk of a postoperative stricture. (clinical) [Ep 4 · 1:35](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=95)
- The rectum is mobilized out until there is slight tension, and the intended cut line will comfortably reach the anal skin. (clinical) [Ep 4 · 1:47](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=107)
- Extra stitches placed into the redundancy help straighten out the rectal tissue prior to incising it. (clinical) [Ep 4 · 2:13](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=133)
- The Lone Star retractor is very helpful to set up the anoplasty. (opinion) [Ep 4 · 2:28](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=148)
- The anoplasty is performed by taking a bite of anal skin to full thickness rectal wall. (clinical) [Ep 4 · 2:47](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=167)
- Dividing the upper and lower quadrants of the left-sided prolapse creates two triangles. (clinical) [Ep 4 · 3:28](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=208)
- All sutures are tied under slight tension, so that once cut, the anoplasty retracts back nicely. (clinical) [Ep 4 · 4:48](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=288)
- There is a tremendous amount of literature on rectal prolapse in the pediatric population — the speaker is being ironic, indicating limited pediatric literature. (opinion) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=0)
- The speaker was trained to test for cystic fibrosis in rectal prolapse patients and answered board questions accordingly, but has never picked up a CF case through rectal prolapse presentation in practice. (clinical) [Ep 1 · 1:20](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=80)
- Initial medical management for rectal prolapse includes treating constipation and limiting toilet sitting time to 5 minutes. (clinical) [Ep 1 · 2:05](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=125)
- The speaker performs resection and rectopexy for rectal prolapse when medical management fails. (clinical) [Ep 1 · 2:16](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=136)
- Anal cerclage works well for rectal prolapse, especially in small babies. (clinical) [Ep 1 · 2:16](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=136)
- Laparoscopic rectopexy to the promontory is performed, with resection if there is a huge redundant segment. (clinical) [Ep 1 · 2:27](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=147)
- Re-operating on patients after sclerosing agent injection is difficult. (clinical) [Ep 1 · 2:48](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=168)
- The speaker has not had success with sclerosing agents and cannot recall a patient who did not ultimately require rectopexy. (clinical) [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=180)
- The speaker has one patient operated on twice through the abdomen, then treated with ventral mesh rectopexy, which has solved the problem so far. (clinical) [Ep 1 · 5:10](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=310)
- Ventral mesh rectopexy involves placing mesh on the anterior surface of the rectum, elevating the rectum without posterior dissection, and tacking the mesh to the sacral promontory; can be done open or laparoscopically. (clinical) [Ep 1 · 5:20](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=320)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A study examined 85 children treated for rectal prolapse after anorectal malformation surgery — Lizzie Lee summarizing a resource [Ep 5 · 0:11](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=11)
- Approximately 30% of children had recurrence of prolapse requiring another repair — Lizzie Lee summarizing a resource [Ep 5 · 0:16](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=16)
- Children without symptoms from prolapse at initial presentation were more likely to develop stricture later — Lizzie Lee summarizing a resource [Ep 5 · 0:20](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=20)
- Surgical repair of asymptomatic rectal prolapse may not be indicated because the treatment itself carries risks — Lizzie Lee summarizing a resource [Ep 5 · 0:26](https://origin-library.globalcastmd.com/watch/morbidity-of-rectal-prolapse-repair-after-surgery-for-anorectal-malformation-10942?t=26)
- A lot of surgeons agree that oftentimes your first shot might be your only shot to give this patient a good outcome and the right anatomy. — Jason Frischer summarizes what Dr. Marc Levitt said [Ep 2 · 0:40](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=40)
- The vast majority of patients who get redos had mislocation, followed by stricture, then less common reasons including remnant of the original fistula (roof), rectal prolapse, and others. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 12:00](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=720)
- Quality of life improved with a redo operation. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 12:30](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=750)
- Patients had an improved ability to achieve continence after redo operations. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 12:40](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=760)
- In the JPS study, 20% of patients with a poor sacrum or poor spine actually developed bowel control after their redo. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 12:55](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=775)
- Patients with good potential (good sacrum and good spine) did extremely well after redo operations. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 13:10](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=790)
- Patients who did not develop voluntary bowel movements after redo were still able to be clean with a bowel management program using enemas or antegrade via a Malone. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 12:50](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=770)
- The average age of patients in the JPS study is about three and a half years, give or take. — Marc Levitt summarizes what Dr. Jason Frischer said [Ep 2 · 13:10](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-2-when-to-redo-a-psarp-3580?t=790)
- The majority of pediatric rectal prolapse cases do not need surgery. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 2:26](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=146)
- The most common reasons for rectal prolapse in children are constipation, sitting on the potty too long, or sitting on it incorrectly. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 2:33](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=153)
- Physical exam is key to distinguish rectal prolapse from intussusception, polyps, and rectal hemorrhoids. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 2:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=175)
- Parents should be taught how to safely reduce a prolapse to avoid incarceration. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 3:39](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=219)
- A 2019 Journal of Pediatric Surgery review of sclerotherapy publications found that alcohol is the most popular sclerosing agent and is pretty effective. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 6:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=391)
- Alcohol as a sclerosing agent is probably really easy to obtain in the hospital setting. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 7:04](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=424)
- Sclerotherapy with ethyl alcohol is the recommended first option after failed conservative management, can be performed up to 3 times, and has an estimated cumulative success rate of a little bit over 80%. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 8:04](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=484)
- Laparoscopic rectopexy is the recommended operative approach for patients who fail sclerotherapy because it has the lowest complication rate and the highest success rate. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 8:12](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=492)
- Patients with rectal prolapse may benefit from a multidisciplinary team approach including behavioral therapy and physical therapy. — em gootee or todd ponsky summarizing the discussion [Ep 3 · 9:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-colorectal-part-2-3834?t=560)
- Rectal prolapse is a very common problem following repair of an anorectal malformation. — The host summarizing a resource [Ep 4 · 0:11](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=11)
- Rectal prolapse can cause mucous production and bleeding. — The host summarizing a resource [Ep 4 · 0:19](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=19)
- Rectal prolapse can interfere with the patient's ability to close the anus and thereby affect their bowel control. — The host summarizing a resource [Ep 4 · 0:19](https://origin-library.globalcastmd.com/watch/rectal-prolapse-repair-following-a-posterior-sagittal-anorectoplasty-9723?t=19)
- Reading the literature, many other practitioners have also not picked up CF patients through rectal prolapse workup, though CF patients may present with prolapse. — The host summarizing the discussion [Ep 1 · 1:50](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=110)
- According to the literature (mostly adult but some pediatric), transabdominal approaches have approximately 5% recurrence rate. — The host summarizing the discussion [Ep 1 · 3:20](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=200)
- Transanal approaches (transanal pull-through or Altmeier procedure) have 15-20% recurrence rate according to the literature. — The host summarizing the discussion [Ep 1 · 3:50](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=230)
- Resection and rectopexy may be better for patients with difficult-to-control constipation, but has a higher complication rate than rectopexy alone. — The host summarizing the discussion [Ep 1 · 4:10](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=250)
- Current literature reports patients going home the next day or even same day after rectopexy. — The host summarizing the discussion [Ep 1 · 4:30](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=270)
- Ventral mesh rectopexy is a newer procedure in adult literature, popularized by the Cleveland Clinic and other centers. — The host summarizing the discussion [Ep 1 · 4:45](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=285)
- There are reports of mesh erosion in the pediatric population, making surgeons cautious about mesh use. — The host summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=300)
- The pathophysiology theory for pediatric rectal prolapse is that the angle of the rectum to the anal canal is straighter in younger patients and becomes more angled with age; ventral mesh rectopexy attempts to change this angulation. — The host summarizing the discussion [Ep 1 · 5:30](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=330)
- Ventral mesh rectopexy is primarily used in older adult women with pelvic floor relaxation issues. — The host summarizing the discussion [Ep 1 · 5:30](https://origin-library.globalcastmd.com/watch/rectal-prolapse-rapid-fire-update-course-2015-983?t=330)

## Changelog
- Sep 16: 1 item added automatically
- Sep 12: 1 item no longer name rectal prolapse
- Sep 7: 2 items added automatically
- Sep 7: 3 items added automatically

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